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CBT Psychotherapy Best For Anxiety Disorders

Posted by Sun on July 23, 2012

A University of Houston researcher has found that patients suffering fromanxiety disorders showed the most improvement when treated with cognitive-behavioral therapy (CBT) — in conjunction with a “transdiagnostic” approach, which allows therapists to use one kind of treatment no matter what the anxiety.

The problem up to now, according to Peter Norton, Ph.D., an associate professor in clinical psychology and director of the Anxiety Disorder Clinic at the University of Houston, has been that each anxiety disorder — such aspanic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), social anxiety disorder, and phobias — has had a targeted treatment.

The transdiagnostic approach recognizes that many overlapping dimensions exist among these anxiety disorders. It suggests that thinking about anxiety disorders as a whole from a behavioral dimension and/or psychological dimension perspective may yield important insights into these disorders.

Norton, who says the specific treatments aren’t all that different from each other, has shown that a combination of CBT with the transdiagnostic approach has proven more effective than CBT combined with other types of anxiety disorder treatments, such as relaxation training.

“The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been an important breakthrough in understanding mental health, but people are dissatisfied with its fine level of differentiation,” he said. The DSM uses a categorical approach to classifying mental disorders, including anxiety concerns.

“Panic disorders are considered something different from social phobia, which is considered something different from PTSD. The hope was that by getting refined in the diagnosis we could target interventions for each of these diagnoses, but in reality that just hasn’t played out.”

Norton’s research began 10 years ago when he was a graduate student in Nebraska and found he couldn’t get enough people together on the same night to run a group session for social phobia.

“What I realized is that I could open a group to people with anxiety disorders in general and develop a treatment program regardless of the artificial distinctions between social phobia and panic disorder, or obsessive-compulsive disorder, and focus on the core underlying things that are going wrong,” said Norton.

He says cognitive-behavioral therapy, which has a specific time frame and goals, is the most effective treatment as it helps patients understand the thoughts and feelings that influence their behaviors. The twist for him was using CBT in conjunction with the transdiagnostic approach.

The patients receiving the transdiagnostic treatment showed considerable improvement, especially with treating comorbid diagnoses, a disease or condition that co-exists with a primary disease and can stand on its own as a specific disease, like depression. Anxiety disorders often occur with a secondary illness, such as depression or substance and alcohol abuse, he noted.

“What I have learned from my past research is that if you treat your principal diagnosis, such as social phobia, you are going to show improvement on some of your secondary diagnosis,” he said. “Your mood is going to get a little better, your fear of heights might dissipate. So there is some effect there, but when we approach things with a transdiagnostic approach, we see a much bigger impact on comorbid diagnoses.”

“In my research study, over two-thirds of [co-existing] diagnoses went away, versus what we typically find when I’m treating a specific diagnosis such as a panic disorder, where only about 40 percent of people will show that sort of remission in their secondary diagnosis,” he continued.

“The transdiagnostic treatment approach [appears to be] more efficient in treating the whole person rather than just treating the diagnosis… then treating the next diagnoses.”

Norton notes the larger contributions of the studies are to guide further development and interventions for how clinical psychologists, therapists and social workers treat people with anxiety disorders. The data collected will be useful for people out on the front lines to effectively treat people to reduce anxiety disorders, he said.

Source: University of Houston


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CBT, Supportive Therapy Equally Effective for Bipolar

Posted by Sun on July 12, 2012

A recent study has found that cognitive behavioral therapy (CBT) and supportive therapy are equally effective in treating the symptoms of bipolar disorder.

Researchers, led by Thomas D. Meyer, PhD, at Eberhard Karls Universität in Tübingen, Germany, wanted to investigate the effectiveness of currently available treatments for the disorder.

Bipolar disorder is a mental illness in which the sufferer experiences extreme and abnormal mood swings, from manichighs to potentially dangerous lowdepression. Over five million people in the United States suffer from bipolar — about 1.6 percent of the population.  It is the sixth leading cause of disability worldwide, and causes significant stress on families and relationships.

Earlier studies have proven that CBT is an effective treatment for the disorder, but these studies did not compare CBT to other types of treatments.

The randomized controlled trial included 76 patients with bipolar I or bipolar II. Patients were given either CBT or supportive therapy for 20 sessions over nine months. The participants were then followed for up to two years.

Both CBT and supportive therapy are psychoanalytic therapies that teach the patient to increase healthy thought processes and behaviors and decrease upsetting thoughts and behaviors.

CBT uses a systematic method to achieve this goal, whereas supportive therapy reinforces and supports the positive, healthy thoughts and behaviors.

The results show that the participants had equal amounts of symptom improvement regardless of the type of treatment. Relapse was also similar for patients in both therapy types.

During the 33 months of the study, 64.5 percent of the participants relapsed regardless of the type of therapy. Relapsing was associated with having bipolar II, the number of previous episodes, and the number of sessions attended before the relapse.

The researchers conclude that both therapies share some characteristics such as mood monitoring and educational components.

These factors might explain the overall benefits of these types of treatments and why they had equally positive effects.

This study was published in Psychological Medicine.

Source: Psychological Medicine 

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Childless Women With Fertility Problems at Higher Risk of Hospitalization for Psychiatric Disorders

Posted by Sun on July 6, 2012

ScienceDaily (July 2, 2012) — While many small studies have shown a relationship between infertility and psychological distress, reporting a high prevalence of anxiety, mood disorders and depressive symptoms, few have studied the psychological effect of childlessness on a large population basis. Now, based on the largest cohort of women with fertility problems compiled to date, Danish investigators have shown that women who remained childless after their first investigation for infertility had more hospitalisations for psychiatric disorders than women who had at least one child following their investigation.

The results of the study were presented July 1 at the annual meeting of ESHRE (European Society of Human Reproduction and Embryology) by Dr Birgitte Baldur-Felskov, an epidemiologist from the Danish Cancer Research Center in Copenhagen.

Most studies of this kind have been based on single clinics and self-reported psychological effects. This study, however, was a nationwide follow-up of 98,737 Danish women investigated for infertility between 1973 and 2008, who were then cross-linked via Denmark’s population-based registries to the Danish Psychiatric Central Registry. This provided information on hospitalisations for psychiatric disorders, which were divided into an inclusive group of “all mental disorders,” and six discharge sub-groups which comprised “alcohol and intoxicant abuse,” “schizophrenia and psychoses,” “affective disorders including depression,” “anxiety, adjustment and obsessive compulsive disorder,” “eating disorders,” and “other mental disorders.”

All women were followed from the date of their initial fertility investigation until the date of psychiatric event, date of emigration, date of death, date of hospitalisation or 31st December 2008, whichever came first. Such studies, said Dr Baldur-Felskov, could only be possible in somewhere like Denmark, where each citizen has a personal identification number which can be linked to any or all of the country’s diagnostic registries.

Results of the study showed that, over an average follow-up time of 12.6 years (representing 1,248,243 woman-years), 54% of the 98,737 women in the cohort did have a baby. Almost 5000 women from the entire cohort were hospitalised for a psychiatric disorder, the most common discharge diagnosis being “anxiety, adjustment and obsessive compulsive disorders” followed by “affective disorders including depression.”

However, those women who remained childless after their initial fertility investigation had a statistically significant (18%) higher risk of hospitalisations for all mental disorders than the women who went on to have a baby; the risk was also significantly greater for alcohol/substance abuse (by 103%), schizophrenia (by 47%) and other mental disorders (by 43%). The study also showed that childlessness increased the risk of eating disorders by 47%, although this was not statistically significant.

However, the most commonly seen discharge diagnosis in the entire cohort (anxiety, adjustment and obsessive compulsive disorders) was not affected by fertility status.

Commenting on the study’s results, Dr Baldur-Felskov said: “Our study showed that women who remained childless after fertility evaluation had an 18% higher risk of all mental disorders than the women who did have at least one baby. These higher risks were evident in alcohol and substance abuse, schizophrenia and eating disorders, although appeared lower in affective disorders including depression.

“The results suggest that failure to succeed after presenting for fertility investigation may be an important risk modifier for psychiatric disorders. This adds an important component to the counselling of women being investigated and treated for infertility. Specialists and other healthcare personnel working with infertile patients should also be sensitive to the potential for psychiatric disorders among this patient group.”

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What Is The Link Between Women’s Hormones And Mood Disorders?

Posted by Sun on July 5, 2012

ScienceDaily (Dec. 12, 2007) — Countless movies and TV shows make light of women’s so-called “moodiness”, often jokingly attributing it to their menstrual cycle or, conversely, to menopause. In fact, mood disorders are a serious and pervasive health problem, and large-scale population studies have found women are 1.5 to 3 times more likely to suffer from major depressive disorder than are men.

In a newly published study, women’s health experts from the University of Alberta argue there is an urgent need for carefully designed, gender-specific research to better understand the relationship of female sex hormones to mood states and disorders.

“The reasons for the gender disparity in rates of depression are not completely understood,” says Kathy Hegadoren, the Canada Research Chair in Stress Disorders in Women at the University of Alberta.

“But there is growing evidence that estrogens have powerful effects beyond their role in reproduction–that they play a critical role in mood disorders in women–and this opens new avenues for research into the underlying biological mechanisms and treatment of depression.”

Estrogen can be used to treat various mood disturbances in women–such as perimenopausal, postmenopausal and postpartum depression–but the results of these treatments can be difficult to interpret because researchers are only beginning to recognize the complex interactions among estrogens, serotonin and mood.

“Right now, clinical use of sex-hormone therapies for the treatment of mood disorders is severely hampered by the inability to predict which women would respond well to such therapies,” explains study co-author and U of A nursing professor Gerri Lasiuk.

“Most animal studies looking at the causes of depression have been conducted with male animals and use chronic-stress models, which are assumed to be similar to depression.”

Hegadoren and Lasiuk’s study recognizes that multiple factors may be at play in the development of mood disturbances, with individual, psychosocial and environmental factors interacting in complicated ways to create differential vulnerability in women and men. But they also point out that the link to sex hormones is hard to deny.

“Previous research has found that, before puberty, the rates of mood and anxiety disorders are similar in boys and girls. It’s only after females begin menstrual function that a gender differential in mood disorders manifests itself. This, coupled with the observation that women appear to be especially vulnerable to mood disturbances during times of hormonal flux, certainly lends support to the claim that a relationship exists between sex hormones and mood,” says Hegadoren.

The study, co-authored by Hegadoren and Lasiuk, appears in the October 2007 issue of the journal Biological Research for Nursing.

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Excessive Worrying May Have Co-Evolved With Intelligence

Posted by Sun on June 22, 2012

ScienceDaily (Apr. 12, 2012) — Worrying may have evolved along with intelligence as a beneficial trait, according to a recent study by scientists at SUNY Downstate Medical Center and other institutions. Jeremy Coplan, MD, professor of psychiatry at SUNY Downstate, and colleagues found that high intelligence and worry both correlate with brain activity measured by the depletion of the nutrient choline in the subcortical white matter of the brain. According to the researchers, this suggests that intelligence may have co-evolved with worry in humans.

“While excessive worry is generally seen as a negative trait and high intelligence as a positive one, worry may cause our species to avoid dangerous situations, regardless of how remote a possibility they may be,” said Dr. Coplan. “In essence, worry may make people ‘take no chances,’ and such people may have higher survival rates. Thus, like intelligence, worry may confer a benefit upon the species.”

In this study of anxiety and intelligence, patients with generalized anxiety disorder (GAD) were compared with healthy volunteers to assess the relationship among intelligence quotient (IQ), worry, and subcortical white matter metabolism of choline. In a control group of normal volunteers, high IQ was associated with a lower degree of worry, but in those diagnosed with GAD, high IQ was associated with a greater degree of worry. The correlation between IQ and worry was significant in both the GAD group and the healthy control group. However, in the former, the correlation was positive and, in the latter, the correlation was negative. Eighteen healthy volunteers (eight males and 10 females) and 26 patients with GAD (12 males and 14 females) served as subjects.

Previous studies have indicated that excessive worry tends to exist both in people with higher intelligence and lower intelligence, and less so in people of moderate intelligence. It has been hypothesized that people with lower intelligence suffer more anxiety because they achieve less success in life.

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With Altered Brain Chemistry, Fear Is More Easily Overcome

Posted by Sun on June 19, 2012

ScienceDaily (June 12, 2012) — Researchers at Duke University and the National Institutes of Health have found a way to calm the fears of anxious mice with a drug that alters their brain chemistry. They’ve also found that human genetic differences related to the same brain chemistry influence how well people cope with fear and stress.

It’s an advance in understanding the brain’s fear circuitry that the research team says may hold particular promise for people at risk for anxiety disorders, including those suffering post-traumatic stress disorder (PTSD).

“What is most compelling is our ability to translate first from mice to human neurobiology and then all the way out to human behavior,” said Ahmad Hariri, a neurobiologist at the Duke Institute for Genome Sciences & Policy. “That kind of translation is going to define the future of psychiatry and neuroscience.”

The common thread in their studies is a gene encoding an enzyme called fatty acid amide hydrolase, or FAAH. The enzyme breaks down a natural endocannabinoid chemical in the brain that acts in essentially the same way that Cannabis, aka marijuana, does (hence the name endocannabinoid).

Earlier studies had suggested that blocking the FAAH enzyme could decrease fear and anxiety by increasing endocannabinoids. (That’s consistent with the decreased anxiety some experience after smoking marijuana.) In 2009, Hariri’s lab found that a common variant in the human FAAH gene leads to decreased enzyme function with affects on the brain’s circuitry for processing fear and anxiety.

In the new study, Andrew Holmes’ group at the National Institute on Alcoholism and Alcohol Abuse tested the effects of a drug that blocks FAAH activity in fear-prone mice that had also been trained to be fearful through experiences in which they were delivered foot shocks.

Tests for the ability of those mice to get over their bad experiences found that the drug allowed a faster recovery from fear thanks to higher brain endocannabinoid levels. More specifically, the researchers showed that those drug effects traced to the amygdala, a small area of the brain that serves as a critical hub for fear processing and learning.

To test for the human relevance of the findings, Hariri’s group went back to the genetic variant they had studied earlier in a group of middle-aged adults. They showed study participants a series of pictures depicting threatening faces while they monitored the activity of their amygdalas using functional magnetic resonance imaging (fMRI) scans. They then looked for how the genetic variant affected this activity.

While the activity of the amygdala in all participants decreased over repeated exposures to the pictures, people who carried the version of the FAAH gene associated with lower enzyme function and higher endocannabinoid levels showed a greater decrease in activity. Hariri says that suggests that those individuals may be better able to control and regulate their fear response.

Further confirmation came from an analysis led by Duke’s Avshalom Caspi and Terrie Moffitt of 1,000 individuals in the Dunedin Study, who have been under careful observation since their birth in the 1970s in New Zealand. Consistent with the mouse and brain imaging studies, those New Zealanders carrying the lower-expressing version of the FAAH gene were found to be more likely to keep their cool under stress.

“This study in mice reveals how a drug that boosts one of the brain’s naturally occurring endocannaboids enables fear extinction, a process that forms the basis of exposure therapy for PTSD,” Holmes said. “It also shows how human gene variation in the same chemical pathways modulates the amygdala’s processing of threats and predicts how well people cope with stress.”

Studies are now needed to further explore both the connections between FAAH variation and PTSD risk as well as the potential of FAAH inhibition as a novel therapy for fear-related disorders, the researchers say.

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Alcohol, Mood and Me (Not You)

Posted by Sun on June 15, 2012

ScienceDaily (Apr. 28, 2011) — Thanks in part to studies that follow subjects for a long time, psychologists are learning more about differences between people. In a new article published in Current Directions in Psychological Science, a journal of the Association for Psychological Science, the author describes how psychologists can use their data to learn about the different ways that people’s minds work.

Most psychology research is done by asking a big group of people the same questions at the same time. “So we might get a bunch of Psych 101 undergrads, administer a survey, ask about how much they use alcohol and what their mood is, and just look and see, is there a relationship between those two variables,” says Daniel J. Bauer of the University of North Carolina at Chapel Hill, the author of the article.

But a one-time survey of a bunch of college students can only get you so far. For example, it might find that sad people drink more, but it can’t tell us whether people drink more at times when they are unhappy, whether the consequences of drinking instead result in a depressed mood, or whether the relationship between mood and alcohol use is stronger for some people than others.

One way psychologists have used to learn more about people is collecting data from people over a longer time period. For example, they might give each subject an electronic device to record blood pressure and stress several times a day, or ask them to log on to a website every night to answer a survey. In one case, Bauer’s colleague, Andrea Hussong, asked adolescents to complete daily diaries with ratings of their mood and alcohol use over 21 days. The data showed that the relationship between mood and alcohol use is not the same for everyone. Adolescents with behavioral problems drink more in general, irrespective of mood, but only adolescents without behavioral problems drink more often when feeling depressed.

Analyzing this kind of data requires tougher math than the simple survey data, which is where quantitative psychologists like Bauer come in. “I think even though a lot of researchers are starting to collect this data, I don’t think they’ve taken full advantage of it,” he says. In the new paper, Bauer points to other methods that can do a better job of showing how variables relate differently for different people.

The point of all of this is to help people, Bauer says. For example, if psychologists discover that certain kinds of people are more likely to drink when depressed, it would be possible to help those people early. “Ultimately, the idea would be to identify people who might be more at risk and try to help them,” he says.

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Depression Treatment Can Prevent Adolescent Drug Abuse

Posted by Sun on June 15, 2012

ScienceDaily (June 4, 2012) — Treating adolescents for major depression can also reduce their chances of abusing drugs later on, a secondary benefit found in a five-year study of nearly 200 youths at 11 sites across the United States.

Only 10 percent of 192 adolescents whose depression receded after 12 weeks of treatment later abused drugs, compared to 25 percent of those for whom treatment did not work, according to research led by John Curry, a professor of psychology and neuroscience at Duke University.

“It turned out that whatever they responded to — cognitive behavioral therapy, Prozac, both treatments, or a placebo — if they did respond within 12 weeks they were less likely to develop a drug-use disorder,” Curry said.

The study found no such relationship when it came to thwarting alcohol abuse, however.

The researchers followed nearly half the 439 participants from the “Treatment for Adolescents with Depression Study” (TADS; 2000-2003), led by Dr. John March, chief of Child and Adolescent Psychiatry at Duke University Medical Center. TADS is considered the largest sample of adolescents who had been treated for major depression.

The participants analyzed by Curry’s study were ages 17-23 at the end of the five-year follow-up study and had no preexisting problems with abusing alcohol or drugs.

“Onset of Alcohol or Substance Use Disorders Following Treatment for Adolescent Depression” (2004-2008), found that marijuana was the most prevalent drug used by study participants (76 percent); other drugs included cocaine, opiates and hallucinogens.

The adolescents must have had at least five symptoms for a length of time to be diagnosed with major depression prior to treatment: depressed mood; loss of interest; disruptions in appetite, sleep or energy; poor concentration; worthlessness; and suicidal thoughts or behavior.

The researchers said that improved mood regulation due to medicine or skills learned in cognitive-behavior therapy, along with support and education that came with all of the treatments, may have played key roles in keeping the youths off drugs.

The researchers were surprised to find no differences in alcohol abuse and do not have an answer for why. Curry thinks the prevalence of alcohol use among people ages 17-23 may be a key factor.

“It does point out that alcohol use disorders are very prevalent during that particular age period and there’s a need for a lot of prevention and education for college students to avoid getting into heavy drinking and then the beginnings of an alcohol disorder,” Curry said. “I think that is definitely a take-home message.”

Alcohol abuse also led to repeat bouts with depression for some participants, he said.

“When the teenagers got over the depression, about half of them stayed well for the whole five-year period, but almost half of them had a second episode of depression,” Curry said. “And what we found out was that, for those who had both alcohol disorder and another depression, the alcohol disorder almost always came first.”

Curry and co-author Susan Silva, associate professor and statistician in the Duke School of Nursing, believe more study is needed because the number of participants who developed drug or alcohol disorders was relatively small.

Also, there was no comparison group of non-depressed patients, so the researchers could not be sure that rates of subsequent drug and alcohol abuse disorders were higher than those for adolescents not treated for depression.

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Molecular Imaging Finds Link Between Low Dopamine Levels and Aggression

Posted by Sun on June 12, 2012

ScienceDaily (June 11, 2012) — Out of control competitive aggression could be a result of a lagging neurotransmitter called dopamine, say researchers presenting a study at the Society of Nuclear Medicine’s 2012 Annual Meeting. During a computer game against a putative cheating adversary, participants who had a lower capacity to synthesize this neurotransmitter in the brain were more distracted from their basic motivation to earn money and were more likely to act out with aggression.

For many people, anger is an almost automatic response to life’s challenges. In clinical psychiatry, scientists look at not only the impact of aggressive behavior on the individual, their loved ones and the community but also the triggers in the brain that lead to aggressive response. The neurobiology of aggression is not well understood, but scientists are aware of a relationship between the neurotransmitter serotonin and certain aggressive behaviors. The objective of this study was to explore whether higher levels of another brain chemical called dopamine, involved in pleasure and reward, increased aggressive response in its subjects. To scientists’ surprise, it was not as they first theorized.

“The results of this study were astonishingly opposite of what was previously hypothesized,” says Ingo Vernaleken, M.D., lead author of the study and research scientist for the department of psychiatry at RWTH Aachen University in Aachen, Germany. “Subjects with more functional dopaminergic reward-systems were not more aggressive in competitive situations and could concentrate even more on the game. Subjects with lower dopaminergic capacity were more likely to be distracted by the cheating behavior.”

In this study, 18 healthy adults in their twenties were tested for aggression using the psychological behavioral task known as the point subtraction aggression paradigm (PSAP). Participants were asked to play a computer game that required them to press a bar multiple times with the incentive of winning money, but they were also told that an adversary in the next room who is able to cheat may steal some of their winnings. What the paranoid participants did not know was that there was no adversary. The computer program is designed to perform randomized deductions of the subjects’ monetary reward to simulate the cheating competitor.The participant had three choices to react: punish the cheater, shield against the adversary by repeatedly pressing a defense button, or continue playing the game in order to maximize their ability to win cash, which indicated resilience.

“The PSAP focuses on aggressive reaction within a competitive situation,” says Vernaleken. “Aggression and its neurobiological mechanisms in humans have been only moderately investigated in the past. Furthermore, most of the previous studies mainly covered the more reactive part of aggression, which merely reflects impulsive behavior and appears to be associated merely with the serotonin system. This investigation focuses on the association with the dopaminergic reward-system, which reflects goal-directed aggression.”

Subjects’ brains were imaged using positron emission tomography, which provides a range of information about physiological functions inside the body, depending on the imaging probe used. In this investigation, F-18 FDOPA, a biomarker that lights up enzymes’ ability to synthesize this transmitter, was used and the uptake of this drug in the brain was analyzed to gauge the correlation between the participants’ dopamine synthesis capacity and aggressive behavior.

Results of the study showed a significant impact on aggressive response in areas in the brain where dopamine synthesis was present, especially in the basal ganglia, which among other functions include the motivation center. Minimized aggression was associated with higher dopamine levels in both the midbrain and the striatum, which plays a role in planning and executive function. People with greater capacity for dopamine synthesis were more invested in the monetary reward aspect of the PSAP, instead of acting in defense or with aggression against their perceived adversary, whereas subjects with lower capacities had a higher vulnerability to act either aggressive, defensive or both.

“Thus, we think that a well-functioning reward system causes more resilience against provocation,” says Vernaleken. “However, we cannot exclude that in a situation where the subject would directly profit from aggressive behavior, in absence of alternatives, the correlation might be the other way around.”

Further research is required to explore the link between dopamine and a range of aggressive behavior. More insight into these relationships could potentially lead to new psychological therapies and drug treatments to moderate or prevent aggressive response.

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Treatment for Social Anxiety

Posted by Sun on June 9, 2012

By: Morty Lefkoe

If you feel emotional discomfort about social situations, interactions with others, or being evaluated or judged by others, you may have “social anxiety” — a problem shared by almost 20 millionothers in the United States.

According to Wikipedia, “The essence of social anxiety has been said to be an irrational or unreasonable expectation of negative evaluation by others.”

The American Psychiatric Association estimates that social anxiety is the number one most common anxiety disorder and is also the third most common mental disorder in the U.S.

Treatment for social anxiety

One of the most common forms of treatment consists of cognitive-behavioral therapy CBT), which attempts to help patients change their thinking process so as to eliminate the negative thoughts that cause social anxiety. When your thinking process changes, you react with less anxiety to situations.

Another approach, which I’ve successfully used with literally thousands of clients, is to help them eliminate the beliefs that cause the social anxiety. Here is a list of the beliefs that I’ve found underlie this common fear for most people.

  1. “Mistakes and failure are bad.”
  2. “I’m not good enough.”
  3. “Change is difficult.”
  4. “I’m not important.”
  5. “What makes me good enough or important is having people think well of me.”
  6. “Nothing I do is good enough.”
  7. “I’m not capable.”
  8. “I’m not competent.”
  9. “I’m inadequate.”
  10. “If I make a mistake or fail I’ll be rejected.”
  11. “I’m a failure.”
  12. “I’m stupid.”
  13. “I’m not worthy.”
  14. “I’ll never get what I want.”
  15. “I’m powerless.”
  16. “People aren’t interested in what I have to say.”
  17. “What I have to say isn’t important.”
  18. “It’s dangerous to have people put their attention on me (something bad will happen).”
  19. “What makes me good enough or important is doing things perfectly.”

If you had these beliefs about yourself, can you see why you would have social anxiety — “an irrational or unreasonable expectation of negative evaluation by others”?

Specifically, if you had the belief, “What makes me good enough or important is having people think well of me,” is it clear that your sense of self-worth would be based on what others thought of you?

And is it real that if you believed, “It’s dangerous to have people put their attention on me (something bad will happen),” you would fear social interaction?

Conditioning also plays an important role

Although my experience with clients has led me to conclude that the primary source of social anxiety is our beliefs, I’ve discovered that conditioning also plays an important role.
The classic example of how conditioning works was an experiment a physiologist named Pavlov conducted with dogs. When presented with food, the dogs salivated. Then a bell was rung just prior to presenting the dogs with food. After numerous presentations of the food with the bell, the bell was rung and no food was delivered. The dogs salivated anyway, because they had associated the bell with the food. In other words, a neutral stimulus that normally would not produce a response does so because it gets associated with a stimulus that does produce a response. In other words, the neutral stimulus gets conditioned.

Here’s an example I use with my clients that will make the process of conditioning very clear. Imagine that I handed you an ice cream cone with one hand and made a fist with my other hand and drew it back as if to hit you. What would you probably feel? Some level of anxiety if you thought you might get hit. Now imagine that the next few times someone handed you an ice cream cone, the same thing happened and you felt anxious each time.

What do you think you would feel the next time you were handed an ice cream cone, even if there was no menacing fist? Probably anxious. And yet it’s clear that ice cream cones are not inherently scary. If this next time there was no fist, only ice cream, why would you feel anxious? Because ice cream cones got conditioned to produce fear. The ice cream cones just happened to be there every time you got scared by the fist.

The principle is that anything that occurs repeatedly (or even once if the incident is traumatic enough) at the same time that something else is causing an emotion will itself get conditioned to produce the same emotion.

There are four important conditionings involved in social anxiety.

  • Conditioning: Fear associated with criticism and judgment.
  • Conditioning: Fear associated with not meeting expectations.
  • Conditioning: Fear associated with people putting their attention on me.
  • Conditioning: Fear associated with rejection.

Can you see how being conditioned to experience fear in these four situations would lead to anxiety in social situations?

When the relevant beliefs and conditionings are eliminated, the social anxiety is also.


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Women More Depressed And Men More Impulsive With Reduced Serotonin Functioning

Posted by Sun on June 4, 2012

ScienceDaily (Sep. 17, 2007) — Women and men appear to respond differently to the same biochemical manipulation. Major depressive disorder (MDD) is one of the most common mental disorders, and it is also one of the most studied.

It is already known that reduced serotonin transmission contributes to the pathophysiology, or functional changes, associated with MDD and most of today’s most popular antidepressants block the serotonin “uptake site”, also known as the transporter, in the brain. It is also known that people with MDD are frequently found to have impaired impulse control.

A new study being published in the September 15th issue of Biological Psychiatry now reports on important sex and genetic differences in the way that men and women react to reductions in serotonin function, specifically in terms of their mood and impulsivity.

Using a technique in healthy participants called acute tryptophan depletion, which decreases serotonin levels in the brain, Walderhaug and colleagues found that men became more impulsive, but did not experience any mood changes in response to the induced chemical changes. However, women in this study reported a worsening of their mood and they became more cautious, a response commonly associated with depression. The researchers also discovered that the mood lowering effect in women was influenced by variation in the promotor region of the serotonin transporter gene (5-HTTLPR).

One of the study’s authors, Dr. Espen Walderhaug, explains, “We were surprised to find such a clear sex difference, as men and women normally experience the same effect when the brain chemistry is changed… Although we have the same serotonergic system in the brain, it is possible that men and women utilize serotonin differently.”

These findings highlight the complexity of studying and treating these disorders, as the interactive effects of gender and genetic coding impacted the outcomes in the men and women when their serotonergic functions were disrupted.

Dr. Walderhaug comments that their study’s findings “might be relevant in understanding why women show a higher prevalence of mood and anxiety disorders compared to men, while men show a higher prevalence of alcoholism, ADHD and impulse control disorders.” John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, adds that the response patterns that have emerged in these findings are “the beginnings of an understanding for these sex-related effects.” Ultimately, it is hoped that these findings further advance the ability to quickly and more accurately treat patients.

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Cognitive Behavioral Therapy for Major Depression

Posted by Sun on June 3, 2012

Modern cognitive behavioral therapy (CBT) was developed independently by two separate individuals: Aaron Beck, a psychiatrist, and Albert Ellis, a clinical psychologist. Both Beck and Ellis began working on their versions of the therapy in and around the late 1950s and early 60s. Both versions of the therapy are founded on the single basic idea that cognition, in the form of thoughts and preconceived judgments, precedes and determines people’s emotional responses.

In other words, what people think about an event that has occurred determines how they will feel about that event. Depression happens because people develop a disposition to view situations and circumstances in habitually negative and biased ways, leading them to habitually experience negative feelings and emotions as a result.

More specifically, Cognitive-Behavioral (CBT) therapists suggest that depression is caused by a combination of an unhelpful dysfunctional thought process and by maladaptive behaviors motivated by that thought process. Because these dysfunctional thoughts and behaviors are learned, people with depression can also learn new, more adaptive skills that raise their mood and increase their ability to cope with daily hassles and stressors. Another basic idea behind CBT is that if a person changes their thoughts and behavior, a positive change in mood will follow.

The cognitive aspect of CBT involves learning to identify distorted patterns of thinking and forming judgments. These maladaptive thought patterns are also known as negative or maladaptive schemas, or core beliefs. Core beliefs are fundamental assumptions people have made that influence how they view the world and themselves.

People get so used to thinking in these core ways that they stop noticing them or questioning them. Simply put, core beliefs are the unquestioned background themes that govern depressed people’s perceptions. For example, a depressed person might think “I am unlovable” or “I am inadequate and inferior” and because these beliefs are unquestioned, they are acted upon as though they are real and true.

Core beliefs serve as a filter through which people see the world. Core beliefs influence the development of “intermediate beliefs”, which are related attitudes, rules and assumptions that follow from core beliefs. When depressed people’s core beliefs are negative and unrealistic, they lead people to experience predominately negative and unrealistic thoughts.

Following along with the example started above, our depressed person might develop the attitude that, “It’s terrible to be unloved”. Similarly, the intermediate belief might include the following rule, “I must please everyone” and an assumption to the effect that, “If I please everyone then people will love me.”

Intermediate beliefs can influence people’s view of a particular situation by generating “automatic thoughts,” the actual thoughts or images that people experience flitting through their minds. Automatic thoughts are evaluative cognitions which occur in response to a particular situation. They are spontaneous (hence the term automatic), rather than the result of deliberate extended thinking or the logical reasoning that occurs when someone concentrates.

Automatic thoughts occur effortlessly, more or less all the time. Most of the time we are unaware that they are occurring, not because they are unconscious sorts of things but rather because we’re so used to them that we don’t notice them anymore. Automatic thoughts influence emotions and behaviors and can provoke physiological responses.

To continue the above example, if a friend of our depressed person does not return a phone call, our depressed person might think, “He’s not calling me back because he hates me”. It may never occur to her to generate alternative and less irrational explanations for the lack of a callback such as,”He must be really busy today.” Because the automatic thought “he hates me” is allowed to stand unchallenged, our depressed person starts feeling hated, and thus depressed.

Though every patient’s automatic thoughts are unique, there are also clear patterns of depressive automatic thoughts that form that are common across many depressed people’s minds. Some common patterns of negative and irrational automatic thoughts include:

  • Catastrophizing – always anticipating the worst possible outcome to occur (e.g., expecting to be criticized or fired when the boss calls).
  • Filtering – exaggerating the negative and minimizing the positive aspects of an experience (e.g., focusing on all the extra work that went into a promotion rather than on how nice it is to have the promotion).
  • Personalizing – automatically accepting blame when something bad occurs even when you had nothing to do with the cause of the negative event (e.g., He didn’t return my phone call because I am a terrible friend or a boring person; I caused him to not call.).
  • (Over)Generalizing – viewing isolated troubling events as evidence that all following events will become troubled (e.g., having one bad day means that the entire week is ruined).
  • Polarizing – viewing situations in black or white (all bad or all good) terms rather than looking for the shades of gray (e.g., “I missed two questions on my exam, therefore I am stupid”, instead of “I need to study harder next time, but hey – I did pretty good anyway!”).
  • Emotionalizing – allowing feelings about an event to override logical evaluation of the events that occurred during the event. (e.g., I feel so stupid that it’s obvious that I’m a stupid person).

Dysfunctional beliefs are thinking habits that people learn which happen to be irrational and not based on reality (e.g., on objective, unbiased observation). Because such beliefs are not linked to reality very well, they tend to appear rather distorted when compared with reality.

Distorted though they may be, dysfunctional beliefs are all people typically have to help them make sense out of the events that happen to them. Snap judgments are made (called Cognitive Appraisals) based on the assumptions present within dysfunctional beliefs, and those judgments end up being, not surprisingly, biased and irrational.

People look to their appraisals of stressful situations to know how to react, and when they do, they see that situations look simply awful (worse than it really would appear if some reality testing were to occur). They react to that false or exaggerated sense of awfulness, and correspondingly experience depressive symptoms.


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People Sometimes Less Trusting When in a Good Mood

Posted by Sun on June 1, 2012

ScienceDaily (Mar. 2, 2010) — It seems to make perfect sense: happy people are trusting people. But a new study suggests that, in some instances, people may actually be less trusting of others when they are in a pleasant mood.

“A person’s mood may determine how much they rely on subtle — or not so subtle — cues when evaluating whether to trust someone,” said Robert Lount, author of the study and assistant professor of management and human resources at Ohio State University’s Fisher College of Business.

In five separate experiments, Lount found that people in a positive mood were more likely than those in a neutral mood to follow cues or stereotypes when determining whether they should trust someone.

If you are predisposed to trust a stranger — because he belongs to the same club as you, or he has a “trustworthy” face — a happy mood makes you even more likely to trust him.

But if you are predisposed to not trust him, a positive mood will make you even less trusting than normal.

“I think the assumption is that if you make someone happy, they are going to be more likely to trust you. But that only works if they are already predisposed to trust you,” Lount said.

“If you’re a professional meeting new clients, you may think if you buy them a nice lunch and make them happy, you’re building trust. But that can actually backfire if the client has some reason to be suspicious of you,” he said.

The study appears in the March 2010 issue of the Journal of Personality and Social Psychology.

All five experiments involved undergraduate students who took part in various scenarios in which they were put into positive or neutral moods, and were then given the opportunity to show trust or distrust toward a stranger.

In one study, for example, participants were first asked to write one of two short essays. Some wrote about an experience that made them happy while others wrote about what they did in a typical day. Those writing tasks were previously shown to put people in a happy or neutral mood.

The participants were then shown a picture of a person and asked a variety of questions designed to find out how much they would trust him. For example, one question asked how likely the participants thought it would be that the person would intentionally misrepresent their point of view to others.

All the pictures were created by a software program that made the faces appear trustworthy or untrustworthy to most people. A trustworthy person had a round face, round eyes and was clean shaven. An untrustworthy person had a narrow face, narrow eyes and facial hair.

The results were striking: participants in a positive mood evaluated the person with the trustworthy features as more trustworthy than did those in a neutral mood.

Conversely, the happy people were less trusting of the person with untrustworthy features than were those in the neutral mood.

“For those in a good mood, it all depended on the cues that the pictured person gave that suggested whether he was trustworthy or not,” Lount said.

But why would happy people rely more on stereotypes and cues to evaluate a person’s trustworthiness?

Research suggests the answer relies on motivation, Lount said.

“When you’re happy, you’re less motivated to carefully process information,” he said.

“You feel like everything is going OK, so there is no reason to search out new information. You can rely on your previous expectations to guide you through a situation.”

Another one of the experiments provided evidence for that theory. In this experiment, the participants were put in a happy or neutral mood. They were then asked to memorize a nine-digit number, which they would be asked to repeat in a few minutes.

Then, they were shown pictures of untrustworthy faces and asked to rate how trustworthy each face looked.

In this case, people in a neutral mood responded much as did the happy people in the previous experiments — they rated untrustworthy faces as even more untrustworthy.

“In this experiment, people’s minds were busy trying to remember the number so they processed information differently than they normally did,” Lount said.

“They relied more on the cues, just like happy people did.”

Lount said people aren’t aware of this process and don’t even know how their mood is affecting how they evaluate others.

“You need to be careful, especially when you’re happy. You should ask yourself how your mood may be affecting your willingness to trust or distrust another person.”

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Happiness: It’s Not in the Jeans

Posted by Sun on June 1, 2012

ScienceDaily (Mar. 8, 2012) — You may throw on an outfit without much thought in the morning, but your choice is strongly affected by your mood. And the item of casual wear in almost everyone’s wardrobe — denim jeans — is what most people wear when depressed, new research from psychologists at the University of Hertfordshire reveals.

A study conducted by Professor Karen Pine, co-author of “Flex: Do Something Different, found that what a woman chooses to wear is heavily dependent upon her emotional state.”* One hundred women were asked what they wore when feeling depressed and more than half of them said jeans. Only a third would wear jeans when feeling happy. In a low mood a woman is also much more likely to wear a baggy top; 57% of the women said they would wear a baggy top when depressed, yet a mere 2% would wear one when feeling happy. Women also revealed they would be ten times more likely to put on a favorite dress when happy (62%) than when depressed (6%).

The psychologists conclude that the strong link between clothing and mood state suggests we should put on clothes that we associate with happiness, even when feeling low.

Professor Pine said: “This finding shows that clothing doesn’t just influence others, it reflects and influences the wearer’s mood too. Many of the women in this study felt they could alter their mood by changing what they wore. This demonstrates the psychological power of clothing and how the right choices could influence a person’s happiness.”

Accessories can make a difference too. The study found that:

  • •Twice as many women said they would wear a hat when happy than when depressed.
  • •Five times as many women said they would wear their favorite shoes when happy (31%) than when depressed (6%).

The study found that ‘happy’ clothes — ones that made women feel good — were well-cut, figure enhancing, and made from bright and beautiful fabrics. Professor Pine pointed out that these are exactly the features that jeans lack: “Jeans don’t look great on everyone. They are often poorly cut and badly fitting. Jeans can signal that the wearer hasn’t bothered with their appearance. People who are depressed often lose interest in how they look and don’t wish to stand out, so the correlation between depression and wearing jeans is understandable. Most importantly, this research suggests that we can dress for happiness, but that might mean ditching the jeans.”

*FLEX: Do Something Different. How to use the other 9/10ths of your personality, by psychologists Professor Ben (C) Fletcher and Professor Karen Pine, published January 2012 by University of Hertfordshire Press.

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Music Changes Perception, Research Shows

Posted by Sun on June 1, 2012

ScienceDaily (Apr. 27, 2011) — Music is not only able to affect your mood — listening to particularly happy or sad music can even change the way we perceive the world, according to researchers from the University of Groningen.

Music and mood are closely interrelated — listening to a sad or happy song on the radio can make you feel more sad or happy. However, such mood changes not only affect how you feel, they also change your perception. For example, people will recognize happy faces if they are feeling happy themselves.

A new study by researcher Jacob Jolij and student Maaike Meurs of the Psychology Department of the University of Groningen shows that music has an even more dramatic effect on perception: even if there is nothing to see, people sometimes still see happy faces when they are listening to happy music and sad faces when they are listening to sad music.


Jolij and Meurs had their test subjects perform a task in which they had to identify happy and sad smileys while listening to happy or sad music. Music turned out to have a great influence on what the subjects saw: smileys that matched the music were identified much more accurately. And even when no smiley at all was shown, the subjects often thought they recognized a happy smiley when listening to happy music and a sad one when listening to sad music.


The latter finding is particularly interesting according to the researchers. Jolij: ‘Seeing things that are not there is the result of top-down processes in the brain. Conscious perception is largely based on these top-down processes: your brain continuously compares the information that comes in through your eyes with what it expects on the basis of what you know about the world. The final result of this comparison process is what we eventually experience as reality. Our research results suggest that the brain builds up expectations not just on the basis of experience but on your mood as well.’

The research was published in the open access journal PLoS ONE on 21 April.

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Treatment for Phobias

Posted by Sun on May 30, 2012

The treatment for Social and Specific Phobias are very similar. Both disorders are treated with cognitive-behavioral therapy, but target different types of cognitive distortions. Additionally, Social Phobia frequently benefits from the addition of social skill training.

Specific Phobias

Cognitive-behavioral therapy for specific phobias is typically a straightforward and systematic approach. Behavioral exposure therapyconsists of gradual exposure to the feared object or situation either in vivo (live), in imagination, or a combination of both. Therapy participants may begin by exposure to photographs of the feared object before facing the real object or situation.

Cognitive therapy can be utilized to address cognitive distortions related to over-estimation of risk or harm associated with the feared object. For example, a person who has developed a fear of snakes may be misinformed and believe that snakes are aggressive and predatory, when in reality their tendency is to hide and avoid human contact.

Social Phobia

Social Phobia responds quite well to standard cognitive-behavioral therapy and studies demonstrate the positive effects of treatment remain after treatment ends (Taylor, 1996). There is evidence that behavioral exposure therapy alone may be as effective as a combination of cognitive and behavioral therapies. (Feske & Chamblass, 1995). Behavioral techniques for social phobia consist of exposing the therapy participant to feared interpersonal situations, such as interacting with strangers or peers, inconveniencing others, and eating in public.

Cognitive therapy frequently focuses on decreasing the excessive concern regarding the opinion of others, as well as correcting the inaccurate belief that inept, social behavior will result in becoming a social outcast. People with social anxiety also display a tendency toward excessive self-monitoring, or self-observation, when faced with anxiety-provoking, social situations.

This excessive self-focus heightens their level of distress by creating more uncomfortable physical sensations of anxiety (such as blushing); which in turn, increases the person’s worry that others will notice, and judge them in a negative way. Self-focus can also interfere with a person’s ability to fully participate in conversations, thereby strengthening their belief that they are socially incompetent.

Often, social skills training can be an important component of treatment. Social skills training is usually delivered in a group therapy format because a therapy group provides an ideal social environment in which to practice these skills. The reason social skills training is so important is because persons with Social Phobia have typically avoided social situations for much of their life.

Thus, they may lack the experience and skills needed to be effective in social situations, and often misread social cues. A high percentage of people with Social Phobia use alcohol to self-medicate before attending social events. Treatment may need to specifically address excessive alcohol use/abuse.


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The Treatment of Panic Disorder

Posted by Sun on May 30, 2012

The Treatment of Anxiety Disorders

Now that we have reviewed the various theories and associated therapies that are used to treat anxiety disorders, we will turn our attention to specific anxiety disorders to describe the usual treatment approach for each disorder. However, it is important to bear in mind, that therapists tailor their treatment approach for each person.

Treatment for Panic Disorder

Panic Disorder is characterized by uncued panic attacks triggered by a false alarm. Cognitive-behavioral therapy for Panic Disorder usually begins with psychoeducation about the disorder. Psychoeducation assists therapy participants (and their family members) to better understand their disorder. This increased understanding serves an important therapeutic purpose. You may recall that two specific cognitive distortions result in an inaccurate appraisal of risk, leading to a subsequent increase in anxiety symptoms: 1) the overestimation of threat and 2) the underestimation of coping abilities.Psychoeducation enables therapy participants to make a more accurate appraisal of risk, and to improve their coping skills in the following ways:

Psychoeducation teaches therapy participants that the physical sensations of the fight-or-flight response are harmless. Therefore, persons-in-recovery learn to more accurately interpret the physical sensations they experience during a panic attack. This increased knowledge helps to reduce the anxiety resulting from an over-estimation of the risk posed by a panic attack. People with Panic Disorder are comforted to know that even though they may feel as though they are losing control, or having a heart attack, these symptoms are perfectly safe, and even adaptive in true situations of danger.

Similarly, people with Panic Disorder benefit from skills training to improve their coping skills through relaxation exercises and breath retraining. Breath retraining involves learning to consciously regulate breath during a panic attack, while relaxation training involves learning to consciously release muscle tension. The purpose of relaxation exercises and breath retraining is to “turn-off” the sympathetic nervous system, which becomes activated during fight-or-flight, and instead “turn-on” the parasympathetic nervous system. In addition, these new skills help to strengthen patients’ appraisal of their coping skills; thereby further reducing their anxiety. These skills can be taught during individual therapy sessions or in a skills-training group.


In addition to psycho-education and skills training, cognitive therapy also helps persons-in-recovery to identify, and target, disorder-specific dysfunctional thoughts, such as the tendency to misinterpret any physical sensation as dangerous or harmful, and the tendency to believe that certain situations “cause” panic attacks (leading to avoidance of those situations). Furthermore, the relationship between underlying life stressors and the initial, uncued panic attacks may be explored. Therapy participants are encouraged to develop strategies to reduce or eliminate these stressors. 

After receiving psychoeducation, skills training, and cognitive therapy, the therapy participant is now ready to participate in the behavioral component of treatment called exposure and response prevention therapy. There are two separate components to the behavioral therapy for Panic Disorder. The first is called interoceptive cue exposure. This type of exposure is meant to desensitize the participant to their specific physical sensations of a panic attack while refraining from his/her typical avoidance or safety behaviors. For example, if a person tends to experience rapid heart rate and perspiration during an attack, the therapist would instruct this person to run up and down stairs in the heat to mimic those same uncomfortable sensations. With repeated practice, the person will no longer become anxious when experiencing these sensations.

Once the therapy participant has learned to become more relaxed in the presence of their physical sensations, the second type of exposure involves confronting the specific situations that typically precipitate their panic attacks, such as an elevator, driving over a bridge, and/or going to a crowded, public place.

Due to the process of paired association, these neutral situations have become linked to the panic attacks and now spontaneously precipitate a panic attack. Therapy participants may practice their relaxation and breath techniques during exposure to prevent a panic attack from occurring.

With practice, the fearful response becomes extinguished: i.e., the exposure to these feared situations, without a panic attack, allows the fear to fade away. In one important study, the combination of interoceptive cue exposure, along with cognitive therapy, led to 85% of the participants being panic-free (Barlow, Craske, Cerny, & Klosko, 1989).

Despite psychoeducation, skills training, and cognitive therapy, some people are unable or unwilling to tolerate exposure therapy. For these people a variety of approaches are still available. Some people with Panic Disorder may benefit from the addition of medication. In addition, the therapist may decide to take a different approach by assisting therapy participants learn to tolerate and accept their symptoms. Both Dialectical Behavior Therapy and Acceptance and Commitment Therapy are useful tools in this regard.


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Bipolar Suicide

Posted by Sun on May 30, 2012

Of primary and significant importance is that family and friends be watchful for signs of suicidal behavior. Suicidal behavior is not always obvious and is seldom predictable, but there are some signs that can trigger family and friends to ask more direct questions, such as, “Are you feeling suicidal at all?” It is okay to ask patients directly whether they are suicidal; there is not any danger that you will “put ideas in their head” as some family members and friends may fear.

Patients’ risk for committing bipolar suicide may be elevated if they display any of the following behaviors:

  • Talking about how they feel suicidal or want to die, or think the world would be a better place without them in it.
  • Feeling hopeless, that nothing will ever change or get better
  • Feeling helpless, that nothing one does makes any difference
  • Feeling like a burden on family and friends.
  • Abusing alcohol or drugs (this is a risk because drugs increase the likelihood that impulsive actions will take place)
  • Putting affairs in order (e.g., organizing finances or giving away possessions to prepare for their death)
  • Writing a suicide note
  • Putting themselves into harm’s way when this is not necessary, or into situations where there is a danger that they will be killed or seriously harmed.

While some bipolar suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out. It is very difficult to prevent the carefully thought out variety of suicides, but some basic precautions can help to minimize the risk for impulsive suicides. The simplest thing to do is to help patients to remove tools that they might use to harm themselves from their home. Guns should not be in the home, for instance (or if they must be in the home, they should be unloaded, and locked up. Unnecessary medications should not be available, and even necessary medications should not be available in quantities that could cause death. Similarly, razors, ropes, cables, saws, blades and other tools that might be used to slash or hang oneself should be removed from the home. There is not any practical way (short of complete imprisonment) to prevent someone from committing bipolar suicide if they are motivated to do so. A motivated patient can throw themselves in front of a car or train, or hang themselves with a shoelace. It is impractical to remove all such tools from patients’ lives. However, taking some precautions to put obvious suicide tools out of immediate reach can and does reduce some suicidal risk.

When patients indicate that they are feeling suicidal, or are experiencing suicidal thoughts, immediate action is appropriate:
  • Call the patient’s doctor or therapist, the local psychiatric (or medical) emergency room, or 911 right away so as to get immediate help and assistance.
  • Make sure the suicidal person is not left alone
  • Make sure that the suicidal person does not have access to large amounts of medication, to weapons, or to other items that could be used for self-harm (e.g., knives, etc.)

Because it is so difficult to accurately predict when people are actually at risk for committing suicide, it is generally appropriate to treat all instances of suicidality as real and serious threats, and to intervene every time. The risk of intervening every time, however, is that bipolar patients cease to talk about their suicidal thoughts after several false alarms, because they no longer want to be shuffled off to the hospital.

Many patients will have ongoing low-level suicidal thoughts for long periods of time and not be in acute danger of acting on them. On the other hand, it is always possible for patients to impulsively act on long-standing suicidal thoughts if they happen to be triggered by particularly disturbing events or at an impulsive point in their mood cycle. The risk for bipolar suicide is highest when patients are in an impulsive state.

Family members and friends have to use careful and conservative judgment when deciding whether to call in the professionals so as to balance patients’ safety against damage to their relationships with patients if suicidal ideation should turn out to be a false alarm. When there is any doubt as to the seriousness of the suicidal threat, it is best to err on the side of safety and to call in the professionals.

Bipolar patients’ suicidal crises are terribly frightening events for family and friends to endure. It is important that family and friends realize that such crises are a normal (if unfortunate) part of more severe bipolar illnesses, and that they will generally pass if the patient experiencing them can be helped through the crisis period.

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Treatment for Post Traumatic Stress Disorder (PTSD)

Posted by Sun on May 30, 2012

Victims of traumatic events experience numerous symptoms which can greatly interfere with their lives. Treatment must address not only the traumatic memories, but many other distressing symptoms, such as interpersonal difficulties, emotional withdrawal, anger, guilt, and depression.Support groups and treatment groups can be extremely beneficial. Prolongedexposure therapy has been found to be quite beneficial and consists of four components: 1) psychoeducation about the effect of trauma, 2) breath retraining, 3) imaginal exposure, and 4) in vivo exposure (Foa, Hembree, & Rothbaum, 2007; Foa, Rothbaum, Riggs, & Murdock, 1991).

People with PTSD are often troubled by their lack of control over their symptoms and their lives. Psychoeducation helps therapy participants (and their families INSERT LINK TO FAMILY THERAPYp59) to understand that their symptoms are a predictable and normal response to trauma. A better understanding of their disorder enables therapy participants to regain a sense of control.

Individuals with PTSD may also benefit from breath retraining, which serves to reduce the uncomfortable physical symptoms of anxiety. Breath re-training is a method of consciously regulating breath, which helps the body “turn-off” the sympathetic nervous system. Furthermore, engaging in deep breathing may facilitate falling asleep, which is a common struggle for individuals with PTSD.

Because direct exposure to the traumatic event is not possible (nor advisable!) imaginal exposure therapy is conducted to help the therapy participant confront their traumatic memories. This involves the therapist gently and systematically assisting the person to gradually recall the traumatic event in greater and more vivid detail. Imaginal exposure is most effective when the person is guided to fully engage in the memory exercises using all five senses. The goal of imaginal exposure therapy is for the therapy participant to integrate the memories of the experience, while developing the ability briefly recall the event, without experiencing panic or anxiety.

In vivo exposure (or real-life exposure), involves confronting situations that trigger the traumatic memory, such as a loud, crowded baseball game that reminds a combat soldier of battle. In addition to these therapeutic techniques, some people will benefit from the addition of medication. Treatment for PTSD can be quite challenging due to the disturbing nature of the traumatic event itself.

Acceptance and Commitment Therapy (ACT) has also become a promising treatment for PTSD. ACT is based on the principle that individuals can learn to tolerate and accept distressing thoughts and emotions, rather than attempting to change them. Therapy participants are guided to live accordingly to their values, rather than according to their symptoms. ACT is particularly useful for people who are unable or unwilling to participate in exposure therapy.

The various forms of exposure therapy are designed to promote new learning, and the extinction of fear responses associated with trauma. A very new and still quite experimental therapy for PTSD, which as of yet has no official name but which we will call Memory Reconsolidation Therapy functions by exploiting a newly discovered and game-changing insight into how learning and memory work called memory reconsolidation. Where extinction based treatments simply compete with or attempt to starve to death established fear responses, reconsolidation-based PTSD treatments, utilizing a combination of imaginal exposure and medications appear to be able to completely erase fear responses. More information on Memory Reconsolidation Therapy for PTSD can be found here.

PTSD and Borderline Personality Disorder are two disorders that frequently co-occur. Borderline Personality Disorder is a fairly severe disorder characterized by emotional dysregulation, interpersonal disharmony, impulsivity, and self-destructive behaviors. In one study, 68% of people with Borderline Personality Disorder also met the criteria for PTSD (Shea, Zlotnick, & Weisberg, 1999). In cases of co-morbid PTSD and Borderline Personality Disorder, Dialectical Behavior Therapy (DBT) is incorporated into the treatment process.


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Treatment for Generalized Anxiety Disorder (GAD)

Posted by Sun on May 30, 2012

Generalized Anxiety Disorder (GAD) is associated with numerous physical symptoms of stress and tension. But, since anxiety is a combination of physical sensations, behaviors, emotions, and thoughts, it is important to target each of these components. Psycho-education is used to teach therapy participants about the physical sensations of anxiety so that the participant learns how to recognize and manage those symptoms.

Progressive muscle relaxation and imagery techniques are extremely useful techniques in managing and reducing these physical sensations. Progressive muscle relaxation teaches individuals how to recognize the difference between physical tension, and relaxation. Consequently, they learn how to consciously relax their muscles. Progressive muscle relaxation consists of the therapist systematically guiding a person to tense, and then relax, multiple major-muscle groups.

Regular practice is the best way to master the technique. Therapists often provide therapy participants with a tape recording of the exercise for homework practice. Imagery techniques consist of guiding people to imagine themselves in a safe and relaxing situation, or to recall a pleasant memory, such as lying on a beach listening to the ocean. Therapy participants learn to use these techniques throughout the day to return to a state of relaxation and calm.

Cognitive therapy focuses on challenging the core belief that the world is a dangerous place and decreasing cognitive distortions such as catastrophic predictions. Furthermore, people with GAD are encouraged to test out their predictions regarding future catastrophes. Exposure and response prevention therapy can be applied during imaginal exercises. This consists of the therapist guiding the therapy participant to imagine a feared future catastrophe. Repeated exposure, via imagination, helps the therapy participant to become desensitized to worries about negative outcomes by imagining them occurring.


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